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Marianne Gill | |||||
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I had been planning this trip for a very long time, so it was with great excitement that I handed in my notice at work and announced my six-month travel itinerary to Thailand, Indonesia, Vietnam and Laos. On my way to the Thai Embassy to pick up my visa, I had to turn back with a very painful leg - this was diagnosed as an extensive deep vein thrombosis. There followed a two-year period when I could go nowhere and was very limited in what I could do. I was constantly in and out of the warfarin clinic getting my blood checked. At one of my visits someone mentioned a monitoring machine, so I investigated it immediately and needed no convincing of its worth. About two months later, with my machine in my backpack, I headed off to South East Asia on a long overdue trip! On arrival in Bangkok, the first thing to hit me was the intense heat. It was a relief to head south to the islands, where I stayed in very basic bungalow huts - often without electricity. A main component in the journey was the jungle - where I went on a three-day trek, visiting remote tribal villages. Walking in such extreme heat and humidity can seriously dehydrate you, which in turn can affect your INR, so it is vital to drink lots of water. The other challenge when travelling around South East Asia was keeping the strips cool, and one becomes very inventive about cool storage solutions! I encountered such a challenge on a four-day boat trip in Indonesia. With no electricity, I had to resort to the beer cooler for storage. After about two days all the ice had melted, but remember that your strips are more resilient than you think. I have prepared a few points to bear in mind if you are thinking of travelling with a monitoring machine.
I am pleased to say that despite being on life-long anticoagulation therapy, I had a very good pregnancy and straightforward labour, the result of which was a healthy baby boy called Malachy! I had an initial consultation with my haematologist to discuss the management of my pregnancy. She advised me that as soon as I found out I was pregnant I was to come off warfarin and transfer to heparin which is administered by injection. Unlike warfarin, heparin does not cross the placenta and is therefore safe to take whilst pregnant. The other difference is that you do not need to check your INR levels. The haematology department showed me how to self-inject, which I did twice a day for the duration of the pregnancy. I got used to the needles and found that varying the injection site minimised the bruising. My husband also helped, as injecting in the upper arm is not easy to do on your own! Having transferred back to warfarin six weeks after the birth of Malachy, I found that it took several weeks to get the right dosage and put this down to my hormones affecting my INR. I am now back on my pre-pregnancy dose and once again self-testing. I did have more scans then is usual during the pregnancy - and what felt like endless midwives’ visits - but was so delighted to have a totally natural and drug-free labour. Incidentally, it is worth knowing that you can breastfeed whilst taking warfarin. | |||||
Case Notes | |||||
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